宫颈高级别上皮内病变宫颈冷刀椎切术后切缘阳性影响因素及其预后随访分析  

Influencing factors of positive margin and follow-up analysis ofprognosis in high-grade cervical intraepithelialneoplasia after cold knife conization

作　　者：蔡阳阳[1] 熊丽丽[1] 付改玲[1] Cai Yangyang;Xiong Lili;Fu Gailing(Gynecology department,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院妇科,河南洛阳471000

出　　处：《青岛医药卫生》2023年第3期196-200,共5页Qingdao Medical Journal

基　　金：2020年度河南省医学科技攻关计划联合共建项目,LHGJ20200591。

摘　　要：目的探究宫颈高级别上皮内病变患者宫颈冷刀锥切术后,引起切缘阳性的影响因素,并对其预后展开随访分析研究。方法回顾性分析2020年5月~2021年12月期间,本院收治的宫颈高级别上皮内病变宫颈冷刀椎切除术患者共计86例。根据患者术后切缘是否呈阳性将其划分为切缘阳性组(n=39)以及切缘阴性组(n=47)。先进行单因素回归分析,将差异存在统计学意义的相关因素纳入Logistic多因素回归分析,并探究影响宫颈冷刀锥切术后切缘阳性的影响因素;对上述研究对象进行为期1年的随访,并分析宫颈冷刀锥切术切缘阳性对其预后的影响。结果切缘阳性组与切缘阴性组患者在是否绝经、有无宫颈糜烂史、病变是否累及腺体、高危型人乳头瘤病毒(HR-HPV)分型感染的不同组别分类上,病例占比差异有统计学意义(P<0.05);Logistic多因素回归分析结果显示,存在宫颈糜烂史、病变累及腺体、HR-HPV分型感染是引起宫颈高级本上皮内病变患者切缘阳性的独立危险因素(P<0.05);随访结果显示,术后3个月、6个月以及9个月期间,切缘阳性组与切缘阴性组患者的疾病复发率差异无统计学意义(P>0.05);术后12个月,切缘阴性组的复发率为4.26%,显著低于切缘阳性组的17.95%(P<0.05)。结论宫颈糜烂史、病变累及腺体以及HR-HPV分型感染同宫颈高级本上皮内病变患者宫颈冷刀锥切术后切缘阳性存在关联;切缘阳性可导致患者术后复发率高,值得临床工作人员重视。Objective To explore the influencing factors of positive margin and follow-up analysis of prognosis in patients with high-grade cervical intraepithelial neoplasia after cold knife conization.Methods A total of 86 patients with high-grade cervical intraepithelial neoplasia undergoing cold knife conization in the hospital were retrospectively analyzed between May 2020 and December 2021.According to presence or absence of postoperative positive margin,they were divided into positive margin group(n=39)and negative margin group(n=47).The influencing factors of positive margin were analyzed by univariate regression analysis,and then those with statistical significance were analyzed by Logistic multivariate regression analysis.All were followed up for 1 year to analyze the effects of positive margin on prognosis.Results There were significant differences between the two groups in menopause,history of cervical erosion,lesions involving glands and different classifications of high-risk human papillomavirus(HR-HPV)infection(P<0.05).The results of Logistic multivariate regression analysis showed that history of cervical erosion,lesions involving glands and different classifications of HR-HPV infection were independent risk factors of positive margin(P<0.05).Follow-up results showed that there was no significant difference in disease recurrence rate between the two groups at 3,6 and 9 months after surgery(P>0.05).At 12 months after surgery,recurrence rate in negative margin group was significantly lower than that in positive margin group(4.26%vs 17.95%,P<0.05).Conclusion The history of cervical erosion,lesions involving glands and different classifications of HR-HPV infection are correlated with positive margin in patients with high-grade cervical intraepithelial neoplasia after cold knife conization.Positive margin will increase postoperative recurrence rate.

关 键 词：宫颈高级别上皮内病 宫颈冷刀锥切术 切缘阳性 预后 

分 类 号：R713.4[医药卫生—妇产科学]